Circumcision Revision

What is circumcision revision?

Circumcision revision is the repair of a previous circumcision. It’s a fairly quick outpatient surgical procedure. But it usually requires general anesthesia.

During a circumcision revision, a healthcare provider surgically cuts and resews the skin of your penis with dissolvable stitches (sutures). This procedure may be necessary if there was unexpected healing from the initial circumcision which led to scar tissue formation, skin abnormalities or penile deformity. You may also need a circumcision revision if you have a serious skin infection, urinary tract infections (UTIs) or inflammation that goes away and comes back (recurrent inflammation) and leads to swelling and/or pain.

Is circumcision revision necessary?

A healthcare provider may recommend circumcision revision if your child has problems with their penis after circumcision. These problems may include:

• Redundant foreskin. The most common reason for a circumcision revision is that too much foreskin remains after a circumcision (redundant foreskin). Extra foreskin isn’t necessarily a dangerous condition. But if your child has problems pulling their foreskin back to keep it clean or develops abnormal scar tissue in the area, it can lead to inflammation, pain and/or infections. Sometimes, the remaining foreskin can become very tight and lead to problems where it gets stuck (phimosis or paraphimosis).
• Entrapped (buried) penis. In some cases, a child’s penis pulls inward instead of sticking out (entrapped, buried or concealed penis). This is usually due to fatty tissue around the penis that goes away as the child grows. It’s a common condition. But sometimes, after circumcision, a child with this condition can have problems in which the remaining penile skin becomes very tight and prevents the penis from being able to come out. An entrapped penis can be painful and difficult to keep clean.
• Penile skin bridge. Penile skin bridges occur when the skin on the shaft of the penis permanently attaches to the head of the penis. This typically occurs very soon after the original circumcision, during the early phases of healing. Penile skin bridges can lead to trapping of skin debris. It can also cause pulling of the penis during erections. Sometimes, it’s difficult to tell the difference between skin bridges (permanent attachment) and penile adhesions (temporary attachment that improves by itself). A careful exam by a pediatric urologist may be necessary to confirm the diagnosis.

Talk to a healthcare provider if you notice any problems with your child’s penis after a circumcision.

How common are circumcision revisions?

Circumcision revision is a relatively common procedure that pediatric urologists perform. Some studies suggest that pediatric urologists perform them more frequently now than in the past. But the reason for this isn’t clear.

How should I prepare my child for circumcision revision?

A circumcision revision is a surgical procedure under general anesthesia. Before a circumcision revision, a healthcare provider will review your child’s health history and perform a physical examination. Tell the provider if your child is taking any medications. Certain medications and/or medical conditions may affect how well your child’s blood can clot and increase their risk of bleeding.

A provider will also give you specific directions on when you shouldn’t allow your child to eat or drink anything before the circumcision revision — usually at least eight hours before the procedure. If your child has food or liquids in their stomach, there’s a risk that they could vomit (throw up) and choke.

Who performs a circumcision revision?

In most cases, a pediatric urologist performs a circumcision revision in a hospital. A pediatric urologist is a doctor who specializes in treating and diagnosing conditions that affect children’s urinary and reproductive systems.

What age is best for circumcision revision?

A circumcision revision can take place at any age. But younger children recover more quickly than older children. A healthcare provider will give you a better idea of when you should expect to schedule the procedure.

Do they put my child to sleep for a circumcision revision?

Yes, an anesthesiologist will give your child general anesthesia before a circumcision revision. Your child will be asleep and won’t feel any pain during the procedure.

What happens during circumcision revision?

The exact procedure depends on why your child needs a circumcision revision. Your child’s pediatric urologist will decide the best approach for your child’s condition.

The urologist uses a surgical knife (scalpel) to remove the extra or abnormal skin and then stitches the remaining skin back together. They’ll also inject some numbing medicine (local anesthetic) as part of the procedure to help with pain.

How long does circumcision revision take?

A circumcision revision usually takes about 30 minutes.

How painful is a circumcision revision?

The penis is a sensitive body part, and a circumcision revision can be moderately painful. Your child won’t feel any pain during the procedure, and they’ll typically get an injection of numbing medicine as part of the surgery to help with pain. During recovery, your child’s penis will be sore and swollen. The pain may last for a few weeks. But it generally improves within a few days.

Older children and adults may have more pain than younger children and babies. Most manage pain and discomfort with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin®) and acetaminophen (Tylenol®). Not everyone can take NSAIDs, so it’s a good idea to check with a provider before you take any or give any to your child.

What should I expect after a circumcision revision?

You can expect the following after a circumcision revision:

• Your child will have swelling, bruising and moderate pain for up to a week or two after a circumcision revision.
• The head of their penis can be raw and inflamed for a week after surgery.
• Their penis can be discolored and appear extra red or purple during the healing phase.
• Stitches may take one to two weeks to dissolve.

Your child may have some bandages or medical skin glue on their penis after surgery. You can help promote healing and reduce the risk of infection by applying a petroleum-based ointment like Vaseline®, Aquaphor® or bacitracin to the penile skin for at least two to three weeks after surgery.

You should be able to sponge-bathe your child after a circumcision revision. But it’s a good idea to avoid a full-body bath until at least two days after the procedure. Carefully wash the area with soap and warm water. Pat the area dry with a towel after the bath and reapply any ointments. Reapply ointments after each diaper change, as well.

What are the benefits of circumcision revision?

The main benefit of a circumcision revision is that it can correct any poor cosmetic results from the original circumcision. It also decreases the risks of:

• Infection.
• Irritation.
• UTIs.
• Sexually transmitted infections (STIs).
• Cervical cancer in sexual partners assigned female at birth (AFAB).

How successful is circumcision revision?

When performed by a qualified healthcare provider, the success rate for circumcision revision is very high.

What are the risks or complications of circumcision revision?

Like all surgeries, circumcision revision has some risks, including:

• Anesthesia risks.
• Bleeding.
• Infection.

In very rare cases, there’s also a risk that redundant foreskin remains.

What is the recovery time after a circumcision revision?

Most people recover within a week to 10 days after a circumcision revision. But in some cases, it may take up to two weeks. Your child’s healthcare provider will give you a better idea of what to expect after the procedure.

As your child recovers, they should avoid lying on their stomach or playing on straddle toys (e.g., rocking horse, see-saw, bicycle or swing).

When can my child go back to school or daycare after a circumcision revision?

It’s a good idea to keep your child home from school or daycare for at least a week after a circumcision revision.

When should I call a healthcare provider?

You should call a healthcare provider as soon as you notice any issues with your child’s penis after a circumcision. If your child needs a circumcision revision, they have a lower risk of developing complications the sooner they go through the procedure.

You should also contact a provider right away if your child has a circumcision revision and develops signs of infection. These signs may include:

• A fever over 100 degrees Fahrenheit (38 degrees Celsius).
• Chills.
• Frequent bleeding.
• Bleeding that doesn’t stop.
• Pus around their incisions.
• Discoloration (red, purple or darker than the usual skin color) that may look like a skin rash.

Will insurance cover circumcision revision?

It depends. Many insurance companies consider a circumcision revision a cosmetic procedure and may not cover it unless there are documented health problems that relate to the original circumcision. But talk to a healthcare provider. They can give you an idea of whether a circumcision revision is medically necessary.

A note from Cleveland Clinic

Circumcision is a very common procedure. But sometimes, there can be complications that require a circumcision revision. As a parent, it can be frustrating to hear that your child may need a circumcision revision. The last thing you want to do is put your child through any additional pain or discomfort or expose them to other surgical risks. Talk to a urologist. They can best advise you on whether your child would benefit from a circumcision revision.